Lebensunwertes Leben is a chilling German phrase that means “life unworthy of life.” It was coined in 1920 by two German professors, Karl Binding and Alfred Hoche, who thought that people with congenital, mental, or developmental disabilities burden their families and the state while contributing nothing. Hoche described such people as “human ballast” and “empty shells of human beings.” These are lives unworthy of life, they argued, and it should be permissible to end them.

That argument was the seed that grew into the horrific fruit of the Holocaust. Before the Nazis built Auschwitz or perfected the gas chamber, there was Knauer, a baby born blind, missing a leg and part of an arm, and considered to be an “idiot.” When a family member requested a “mercy killing” for Knauer, Hitler and his personal physician, Karl Brandt, directed doctors at the University of Leipzig to end Knauer’s life.

And that is how the Nazi euthanasia program began. From 1939 to 1945, at least five thousand other children would be killed in German hospitals. From killing children, they progressed to killing adults, then prisoners, and finally Jews. Mass genocide was simply the logical conclusion following the premise that some human lives are unworthy of life.

Curing by Killing

It may seem hard to imagine living in such a barbaric society. The awful reality is that we already do. In the United States, 67–85 percent of babies diagnosed with Down syndrome are aborted. The numbers are similar for babies with anencephaly and spina bifida (83 percent and 63 percent, respectively).

“Mass genocide was simply the logical conclusion following the premise that some human lives are unworthy of life.”

In our “civilized” society, it is simply assumed that a prenatal diagnosis of lethal, life-limiting, or severely debilitating disorders justifies abortion. The medical euphemism used to describe those babies and their conditions is “incompatible with life.” That is our version of lebensunwertes leben.

How do doctors sworn to preserve life come to destroy life? According to Dr. Robert Jay Lifton, who personally interviewed German doctors involved in mass killings, the fundamental shift happened when doctors convinced themselves that killing was healing.

Today, we live in a society that similarly confuses the murder of unborn babies for medical care. In 2017, CBS News tweeted, “Iceland is on pace to virtually eliminate Down syndrome through abortion.” In 2019, a UK woman said, “I aborted my disabled baby girl after [the] 20-week scan to free her from a life of pain and suffering.” It sounds more civilized to reframe personal convenience as compassion, but killing babies with disabilities is not curing. “Woe to those who call evil good and good evil, who put darkness for light and light for darkness, who put bitter for sweet and sweet for bitter!” (Isaiah 5:20).

‘Wonderful Are Your Works’

A society shaped by atheistic materialism and Darwinian evolution can never account for the worth of persons with disabilities — because such a society does not account for God. Christians, however, are compelled to protect and care for babies with disabilities simply because they are humans made in the image of our God.

For me, this issue transcends stats or abstract moral dilemmas. I am the proud father of twin sons whose lives, in the judgment of many, would not be worth living. They were born with a condition called nemaline myopathy, which causes extreme muscle weakness. One passed away at the age of 3; the other is now 8. Caring for such weak and dependent children has deepened my understanding of the image of God.

In Psalm 139:13–14, David prays,

You formed my inward parts;
     you knitted me together in my mother’s womb.
I praise you, for I am fearfully and wonderfully made.
     Wonderful are your works;
     my soul knows it very well.

Because of my sons’ condition, I’ve wrestled with the question, Can my son pray those words? Can he say to God, “You made me, and I am one of your wonderful works”? Or does his disability make him defective?

It’s one thing for armchair philosophers to contemplate such questions, but for wheelchair sufferers like my son, these are serious questions. And there are serious answers in accounting for God, and what it means for humans to be made in his image.

Image of God

In Scripture, the first sanction against murder is explicitly grounded in the fact that “God made man in his own image” (Genesis 9:6). But what is the image of God? Is it found in a specific set of functions or features humans possess? Is it our intellect, our moral reasoning, our relational capacity, or our physical ability to take dominion over the world? If so, some people might possess more or less of the image of God than others. More importantly, some humans might have more of a right to life than others.

Peter Singer, a professor of bioethics at Princeton, believes that the value of human life depends on functions like rationality and autonomy. He openly says that disabled infants “lack these characteristics. Killing them, therefore, cannot be equated with killing normal human beings or any other self-aware beings” (Practical Ethics, 160). In Singer’s world, the most vulnerable among us are the most expendable.

“The one thing each one of us shares in common with every other is our humanness — the image of God.”

But according to Scripture, the image of God is not something humans bear or possess; it is what we are as humans. The Dutch theologian Herman Bavinck said, “The essence of human nature is its being [created in] the image of God” (Reformed Dogmatics, 2:554). That is, to be human is to be in God’s image.

Our appearances, capabilities, and experiences vary, but the one thing each one of us shares in common with every other is our humanness. Again, Bavinck powerfully states the point:

It follows from the doctrine of human creation in the image of God that this image extends to the whole person. Nothing in a human being is excluded from the image of God. While all creatures display vestiges of God, only a human being is the image of God. And he is such totally, in soul and body, in all his faculties and powers, in all conditions and relations. (555)

The most critical distortion to the image of God is not disability but sin. And even though Adam’s sin skewed the image of God in man, it did not erase it. Neither could sin thwart God’s purpose to fill the earth with humans made in his image. While the first man failed to image his glory, and we all too have fallen short of his glory, Christ is the perfect “image of the invisible God” (Colossians 1:15). Fully God and fully man, Christ came as man, the ultimate human, and died in our place so that we could be redeemed and begin being conformed to his image (Romans 8:29; 2 Corinthians 3:18). So, for Christians, humanness means even more — not only in imaging our God but also his Son.

That is gloriously true for my son and for all children with disabilities or life-limiting conditions, whether born or unborn. Christ is the image of God, and in him, we who were made in God’s image, and have sinned, are invited into redemption. To judge any human as unworthy of life is to defame the image of our God and his Son. To put them to death — even in the name of mercy or medicine — is to desecrate the glory of Christ.